Hiperplasia prostática benigna (HPB), sintomas do trato urinário inferior (LUTS) e função sexual / Benign Prostatic Hyperplasia (BPH), Lower Urinary Tract Symptoms (LUTS), and Sexual Function

A hiperplasia prostática benigna (HPB) representa o crescimento não maligno do tecido da próstata. Proliferação de células estromais e epiteliais na zona de transição da próstata causa compressão uretral e obstrução do fluxo vesical. Isso pode levar a manifestações de LUTS (lower urinary tract symptoms): urgência urinária, noctúria, dificuldades de micção, esvaziamento incompleto da bexiga, menor força e/ ou interrupção do jato e inflamações. Mecanismos do LUTS/HPB compartilhados afetam a função sexual masculina. Atividade aumentada de subtipos de receptores α1-adrenérgicos na próstata está associada à HPB. Tais receptores, também presentes no pênis, podem inibir a ereção, devido à HPB. Quanto à correlação entre LUTS e disfunção sexual, aventa-se que ambas resultem da contração anômala da musculatura lisa, por ativação dos receptores α1-adrenérgicos. LUTS/HPB causam desconforto nos homens, devido à obstrução urinária, ejaculação dolorosa, disfunção erétil (DE), distúrbios ejaculatórios e baixa libido, que prejudicam a qualidade de vida, deles e de suas parcerias. A noctúria interfere negativamente na qualidade do sono e na disposição para a atividade sexual. Tratamentos para LUTS/HPB podem induzir disfunções sexuais. Entre eles, ressecção transuretral (RTU), α1-bloqueadores, inibidores da 5α-redutase e terapia combinada (α1-bloqueador e 5α-redutase). Os efeitos prejudiciais do LUTS/HPB e de seu tratamento sobre a função sexual ainda são subdiagnosticados e insuficientemente tratados. A atividade sexual deve ser investigada antes e durante o tratamento, também orientando o paciente sobre os possíveis efeitos de cada opção terapêutica sobre a função sexual, evitando-se assim o abandono do tratamento.

Comparative analysis between open transvesical and laparoscopic adenomectomy in the treatment of benigne prostatic hyperplasia in a tertiary hospital in Curitiba-PR: a retrospective study / Análise comparativa entre adenomectomia transvesical aberta e videolaparoscópica no tratamento da hiperplasia prostática benigna em hospital terciário de Curitiba - PR: estudo retrospectivo

ABSTRACT Objective: the aim of this study was to compare the results of open and videolaparoscopic transvesical prostatectomy techniques in the treatment of benign prostatic hyperplasia (BPH) in a tertiary hospital. Methods: we reviewed medical records of patients who underwent transvesical adenectomy due to BPH between March 2019 and March 2021 at the urology service of Hospital de Clínicas do Paraná (HCPR), 42 patients were included in the open transvesical prostatectomy group and 22 in the videolaparoscopic group. Then, a comparison was made between the techniques in terms of surgical time, bleeding, length of stay, need for intensive care, among others, in addition to postoperative outcome. Results: the mean surgical time was shorter in the open technique compared to the laparoscopic technique (141 min vs 274 min). The videolaparoscopic group had a shorter mean hospital stay (3.5 days vs 6.36 days). There was no statistical significance in the comparison regarding the need for an intensive care unit, as well as in the assessment of postoperative bleeding. Conclusion: comparatively, the techniques demonstrated a similar outcome, with a low rate of complications and satisfactory results for the treatment of BPH. The laparoscopic technique is a surgery with a shorter hospital stay, but at the expense of a longer surgical time.

RESUMO Objetivo: o objetivo deste estudo foi comparar o resultado das técnicas de prostatectomia transvesical aberta e videolaparoscópica no tratamento de hiperplasia prostática benigna (HPB) em um hospital terciário. Métodos: foram revisados prontuários de pacientes submetidos a adenectomia transvesical devido a HPB entre março de 2019 a março de 2021 no serviço de urologia do Hospital de Clínicas do Paraná (HCPR), sendo incluídos 42 pacientes no grupo prostatectomia transvesical aberta e 22 no grupo videolaparoscópico. Em seguida foi feita a comparação entre as técnicas nos quesitos tempo cirúrgico, sangramento, tempo de internamento, necessidade de terapia intensiva, entre outras, além de desfecho pós-operatório. Resultados: o tempo cirúrgico médio foi menor na técnica aberta em comparação com a técnica videolaparoscópica (141 min vs 274 min). O grupo videolaparoscópico apresentou um tempo médio de internamento menor (3,5 dias vs 6,36 dias). Não houve significância estatística na comparação quanto a necessidade de unidade de terapia intensiva, assim como na avaliação do sangramento pós-operatório. Conclusão: comparativamente, as técnicas demonstraram um desfecho semelhante, com baixa taxa de complicações e resultados satisfatórios para o tratamento da HPB. Sendo a técnica videolaparoscópica uma cirurgia com menor tempo de internamento, porém às custas de um maior tempo cirúrgico. .

Flujometría manual en la evaluación clínica y terapéutica de pacientes con hiperplasia prostática benigna / Manual flowmetry in the clinical and therapeutic evaluation of patients with benign prostatic hyperplasia

Introducción: La hiperplasia prostática benigna es una enfermedad frecuente que aumenta su incidencia con la edad. Su patogenia no está clara aún y su cuadro clínico típico es la obstrucción urinaria progresiva con pérdida de calidad de vida. Objetivos: Evaluar el valor predictivo de la flujometría manual en la definición de la conducta terapéutica en pacientes con hiperplasia prostática benigna y determinar la evolución de dichos pacientes en el tiempo. Método: Se realizó un estudio descriptivo, prospectivo y longitudinal de 50 pacientes, diagnosticados como portadores de hiperplasia prostática benigna, desde los puntos de vista clínico e imagenológico, atendidos en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero del 2017 hasta igual periodo del 2019. Resultados: La flujometría manual realizada al inicio demostró que 62,0 % de la muestra tenía una tasa de flujo urinario promedio por debajo del rango fisiológico y 22,0 % se encontraba en rango limítrofe o dudoso. Recibieron tratamiento quirúrgico 37 pacientes (74,0 %); 13 (26,0 %) fueron medicados y con seguimiento clínico. Se realizó la resección transuretral de la próstata con una rápida recuperación de los pacientes y en solo 2,0 % hubo complicaciones. Conclusiones: La flujometría manual resultó útil para determinar la conducta a seguir en la mayoría de los pacientes estudiados y en el seguimiento a corto plazo de quienes fueron operados.

Introduction: The benign prostatic hyperplasia is a frequent disease that increases its incidence with the age. Its pathogenesis is not still clear and its typical clinical pattern is the progressive urinary obstruction with loss of life quality. Objectives: To evaluate the predictive value of manual flowmetry in the definition of the therapeutic behavior in patients with benign prostatic hyperplasia and to determine the evolution of these patients as time goes by. Method: A descriptive, prospective and longitudinal study of 50 patients diagnosed with benign prostatic hyperplasia was carried out, from the clinical and imaging points of view, who were assisted in Saturnino Lora Torres Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba, from January, 2017 to the same period in 2019. Results: The manual flowmetry carried out demonstrated at the beginning that 62.0 % of the sample had a rate of average urinary flow below the physiologic range and 22.0 % was in bordering or doubtful range. Thirty seven patients received surgical treatment (74.0 %); thirteen patients (26.0 %) received medication and with clinical follow up. The transurethral resection of prostate was carried out with a quick recovery of the patients and there were complications just in a 2.0 %. Conclusions: The manual flowmetry was useful to determine what to do in most of the studied patients and in the short term follow up of those who were operated.

Tratamiento quirúrgico de la hiperplasia prostática benigna: comparación entre enucleación láser, resección trans uretral y adenomectomía abierta

Objetivo: Comparar el resultado actual de tres técnicas quirúrgicas en pacientes intervenidos por Hiperplasia Benigna de Próstata (HPB); Enucleación láser de próstata (HoLEP), Resección transuretral (RTU) y Prostatectomía Abierta (PA). Enfermedad que actualmente presenta cambios en su presentación clínica y mayores comorbilidades al momento de la cirugía. Materiales y Método: Análisis retrospectivo de 1. 211 pacientes consecutivos e intervenidos en un mismo centro por HPB entre 2008 y 2017 y con al menos 6 meses de evaluación posoperatoria. Se registró las características periperatorias y comorbilidades, comparando los resultados intra y post operatorios obtenidos según la técnica quirúrgica empleada. Se realizó análisis uni y bivariados en programa SPSS versión 17. Para comparar variables categóricas empleamos test exacto de Fisher y para las variables continuas la prueba de Mann-Whitney. Resultados: Al momento de la cirugía 769 pacientes (63,5%) se encuentran en terapia médica por HPB, 268 (22,1%) presentan retención urinaria y 212 (17,5%) se encuentran en terapia anticoagulante-antiagregante. Se realizó HoLEP en 423 pacientes (36,9%), RTU en 651 (56,9%) y PA en 71 (6,2%). Aquellos intervenidos por HoLEP tienen significativa mayor frecuencia de terapia anticoagulante preoperatoria que RTU (9,2% v/s 4,9 %), manteniendo similar tasa de transfusión en post operatorio (0,5%). La mayor necesidad de transfusión la presentan los intervenidos por PA 5,6%. El tiempo de cateterismo y estadía hospitalaria es significativamente más breve en quienes se someten a HoLEP; 3,7 días v/s 4,4 en RTU y 7,1 en PA. También resultan determinantes del tiempo estadía hospitalaria la edad, presencia de cardiopatía coronaria y falla renal. Al sexto mes de la cirugía los pacientes intervenidos por HoLEP tienen un significativo mejor flujo urinario máximo y menor volumen residual. Conclusiones: En esta serie, los pacientes con HBP al momento de requerir cirugía presentan condiciones que se asocian a mayor tiempo de hospitalización: edad, cardiopatía coronaria y falla renal. Confirmamos que aquellos intervenidos con HoLEP registran una hospitalización significativamente más breve y resultados funcionales similares a RTU y PA.

Aim: To compare the current results of three surgical techniques in patients operated on for Benign Prostate Hyperplasia (BPH); Laser Enucleation of the Prostate (HoLEP), Transurethral Resection (TURP) and Open Prostatectomy (PA). Disease that currently presents changes in its clinical presentation and greater comorbidities at the time of surgery. Materials and Method: Retrospective analysis of 1211 consecutive patients operated on in the same center for BPH between 2008 and 2017 and with at least 6 months of postoperative evaluation. The periperative characteristics and comorbidities were recorded, comparing the intra- and post-operative results obtained according to the surgical technique used. A univariate and bivariate analysis was performed using SPSS version 17. To compare categorical variables, we used Fisher's exact test and the Mann-Whitney test for continuous variables. Results: At the time of surgery 769 patients (63.5%) were on medical therapy for BPH, 268 (22.1%) had urinary retention and 212 (17.5%) were on anticoagulant-antiplatelet therapy. HoLEP was performed in 423 patients (36.9%), TURP in 651 (56.9%) and PA in 71 (6.2%). Those operated on by HoLEP had a significantly higher frequency of preoperative anticoagulant therapy than TURP (9.2% vs. 4.9%), maintaining a similar transfusion rate postoperatively (0.5%). The greatest need for transfusion is presented by those operated on by AP 5.6%. The time of catheterization and hospital stay is significantly shorter in those who undergo HoLEP; 3.7 days v / s 4.4 in TUR and 7.1 in PA. Age, presence of coronary heart disease and kidney failure are also determinants of the length of hospital stay. At the sixth month after surgery, patients operated on by HoLEP had a significantly better peak urinary flow and lower residual volume. Conclusions: In this serie, patients with BPH at the time of requiring surgery, presents conditions that are associated with a longer hospitalization time: age, coronary heart disease and kidney failure. We confirmed that those who underwent HoLEP had a significantly shorter hospitalization and functional results, similar to TURP and AP

Protection of nontarget structures in prostatic artery embolization / Proteção de estruturas não alvo na embolização de artérias prostáticas

Abstract Objective: To describe the efficacy and safety of protective embolization during prostatic artery embolization, as well as to discuss its clinical relevance. Materials and Methods: This was a retrospective, observational, single-center study including 39 patients who underwent prostatic artery embolization to treat lower urinary tract symptoms related to benign prostatic hyperplasia between June 2008 and March 2018. Follow-up evaluations, performed at 3 and 12 months after the procedure, included determination of the International Prostate Symptom Score, a quality of life score, and prostate-specific antigen levels, as well as ultrasound, magnetic resonance imaging, and uroflowmetry. Results: Protective embolization was performed in 45 arteries: in the middle rectal artery in 19 (42.2%); in the accessory internal pudendal artery in 11 (24.4%); in an internal pudendal artery anastomosis in 10 (22.2%); in the superior vesical artery in four (8.9%); and in the obturator artery in one (2.2%). There was one case of nontarget embolization leading to a penile ulcer, which was attributed to reflux of microspheres to an unprotected artery. There were no complications related to the protected branches. All of the patients showed significant improvement in all of the outcomes studied (p < 0.05), and none reported worsening of sexual function during follow-up. Conclusion: Protective embolization can reduce nontarget embolization during prostatic artery embolization without affecting the results of the procedure. In addition, no adverse events other than those expected or previously reported were observed. Therefore, protective embolization of pudendal region is safe.

RESUMO Objetivo: Descrever a eficácia e a segurança da embolização de proteção na embolização de artérias prostáticas e discutir sua relevância clínica. Materiais e Métodos: Estudo retrospectivo, observacional, de um único centro, que inclui 39 pacientes submetidos a embolização de artérias prostáticas para tratamento de sintomas do trato urinário inferior relacionados a hiperplasia benigna da próstata, de junho de 2008 a março de 2018. O acompanhamento foi realizado em 3 meses e 12 meses, incluindo International Prostate Symptom Score, escore de qualidade de vida, antígeno prostático específico, ultrassom, ressonância magnética e urofluxometria. Resultados: Embolização de proteção foi realizada em 45 artérias: artérias retais médias em 19 (42,2%); artérias pudendas internas acessórias em 11 (24,4%); anastomoses com ramos da artéria pudenda interna em 10 (22,2%); artérias vesicais superiores em quatro (8,9%); e artéria obturatória em uma (2,2%). Houve um caso de embolização não alvo que provocou uma úlcera peniana, atribuída a refluxo de partículas para uma artéria não protegida. Não houve complicações relacionadas com os ramos protegidos. Os pacientes apresentaram melhora significativa em todos os resultados estudados (p < 0,05) e não relataram piora da função sexual durante o acompanhamento. Conclusão: Embolização de proteção pode ser realizada para diminuir embolização não alvo sem interferir nos resultados da embolização de artérias prostáticas. Além disso, não foi observado nenhum evento adverso diferente dos já esperados ou previamente publicados. A embolização de proteção na região pudenda é segura.

Validation of the mindray BC6000 hematology analyzer for erythroblast counting in peripheral blood / Validação do analisador hematológico Mindray BC6000 para a contagem de eritroblastos em sangue periférico

ABSTRACT Introduction Differential counting of erythroblasts in blood samples by hematology analyzers still has limitations. Technological advances in blood count equipment have proposed the fully automated counting of these cells, however, not without its validation. Objective Validate the automated count of erythroblasts in peripheral blood in the Mindray BC6000 hematology analyzer and verify the existence of correlation of the maturation stages of erythroblasts with the equipment's graphics. Material and Methods Prospective study with peripheral blood samples from the Clinical Pathology Laboratory Dr Paulo C. Azevedo, regardless of age and gender, to validate the erythroblast count in the Mindray BC6000 hematology analyzer compared to the manual method (gold standard), in the period of June 2019 to December 2020. Results Seventeen peripheral blood samples were analyzed from newborns (09/17 - 52.3%) and from patients older than 2 years (08/17 - 47.7%) who had more than 18% of erythroblasts after morphological analysis of the sample. Statistical analysis of erythroblast counts by the two methodologies showed that the Mindray BC6000 hematological counter has good reproducibility, precision and linearity. There was no correlation between the maturation stages of erythroblasts and the equipment graphics. Conclusion The proposed validation showed that the Mindray BC6000 hematological counter has good analytical performance for counting erythroblasts in peripheral blood. However, there is no correlation between the maturation stages of erythroblasts with the graphics generated by the equipment.

RESUMO Introdução A contagem diferencial de eritroblastos em amostras de sangue por analisadores de hematologia ainda apresenta limitações. Os avanços tecnológicos nos equipamentos de hemograma têm proposto a contagem totalmente automatizada dessas células, porém, não sem sua validação. Objetivo Validar a contagem automatizada de eritroblastos no sangue periférico no analisador hematológico Mindray BC6000 e verificar a existência de correlação dos estágios de maturação dos eritroblastos com os gráficos do equipamento. Material e Métodos Estudo prospectivo com amostras de sangue periférico do Laboratório de Patologia Clínica Dr. Paulo C. Azevedo, independente de idade e sexo, para validação da contagem de eritroblastos no analisador hematológico Mindray BC6000 em comparação ao método manual (padrão ouro), no período de junho de 2019 a dezembro de 2020. Resultados Foram analisadas 17 amostras de sangue periférico de recém-nascidos (17/09 - 52,3%) e de pacientes maiores de 2 anos (17/08 - 47,7%) que apresentavam mais de 18% de eritroblastos após análise morfológica da amostra. A análise estatística das contagens de eritroblastos pelas duas metodologias mostrou que o contador hematológico Mindray BC6000 tem boa reprodutibilidade, precisão e linearidade. Não houve correlação entre os estágios de maturação dos eritroblastos e os gráficos do equipamento. Conclusão A validação proposta mostrou que o contador hematológico Mindray BC6000 apresenta bom desempenho analítico para contagem de eritroblastos em sangue periférico. Porém, não há correlação entre os estágios de maturação dos eritroblastos com os gráficos gerados pelo equipamento.

Serum levels of interleukin-2 differ between prostate cancer and benign prostatic hyperplasia / Níveis séricos de interleucina-2 diferem entre câncer de próstata e hiperplasia benigna da próstata

ABSTRACT Objective Investigation onthe systemic inflammatory profile ofpatients affected by prostate cancer (PCa) or prostatic hyperplasia (BPH) may contribute to characterize the pathological profile as well as enable identification of markers and promote alternatives for appropriate, less invasive treatments. Methods This research compared serum levels of 10 classic inflammatory mediators among patients aged 50 years or older affected by PCa or BPH. For this, clinical, biochemical, metabolic, anthropometric and inflammatory aspects of each patient was considered. Results From the statistical analysis, a weakpositive correlation (r = 0.16) between IL-2 with serum total PSA values was found. In addition, median serum IL-2 values were three times higher in patients with PCa compared to BPH patients. Conclusion By interpretation of current literature, we hypothesize that the activity of infiltratedtype M1 macrophages and activated cytotoxic cells in the neoplasm milieu might explain this increase of IL-2 as part of anendogenous anti-neoplastic response.

RESUMO Objetivo A investigação do perfil inflamatório sistêmico de pacientes acometidos por câncer de próstata (CaP) ou hiperplasia prostática (HPB) pode contribuir para caracterizar o perfil patológico, bem como possibilitar a identificação de marcadores e promover alternativas de tratamentos adequados e menos invasivos. Métodos Esta pesquisa comparou os níveis séricos de 10 mediadores inflamatórios clássicos em pacientes com 50 anos ou mais afetados por CaP ou HPB. Para tanto, foram considerados os aspectos clínicos, bioquímicos, metabólicos, antropométricos e inflamatórios de cada paciente. Resultados A partir da análise estatística, foi encontrada umacorrelação positiva fraca (r = 0,16) entre IL-2 com os valores de PSA total sé o. Além disso, os valores medianos de IL-2 no soro foram três vezes maiores em pacientes com CaP em comparação com pacientes com HPB. Conclusão Pela interpretação da literatura atual, hipotetizamos que a atividade de macrófagos do tipo M1 infiltrados e células citotóxicas ativadas no meio da neoplasia pode explicar esse aumento de IL-2 como parte de uma resposta antineoplásica endógena.

Avaliação de fatores de risco e antígeno prostático específico no rastreamento de câncer de próstata / Evaluation of risk factors and prostate-specific antigen in prostate cancerscreening

Introdução: no Brasil, o câncer de maior incidência nos homens é o câncer de próstata (CaP), com 6,9% de mortalidade. Atualmente, discute-se a aplicabilidade do antígeno prostático específico (PSA) em políticas de rastreamento para CaP e os riscos associados ao sobrediagnóstico. Objetivo: correlacionar a dosagem do PSA com fatores de risco, história clínica e a presença de neoplasia prostática. Metodologia: estudo descritivo transversal que analisou, comparativamente, dados clínico-epidemiológicos e níveis séricos de PSA de 200 pacientes. Valores de PSA foram estratificados em três categorias (<2,5, 2,5­10,0 e >10 ng/ml). Resultados: os fatores de risco analisados foram relacionados significativamente com o aumento do PSA e neoplasia prostática. A prevalência de CaP (11%) e hiperplasia prostática (61%) foi observada nos pacientes com maior dosagem de PSA, enquanto 1% dos pacientes apresentou CaP sem alteração do PSA e 4% tiveram CaP com 2,5­10,0 ng/ml de PSA. Maiores níveis séricos do biomarcador foram relacionados a diabetes (70%), hipertensão (77%), uso crônico de medicações (60%) e ausência de exames periódicos (58%). O grupo com PSA >10 ng/ml teve média de idade maior que o primeiro (p = 0,002) e o segundo grupos (p = 0,027). Conclusão: a prevalência de hiperplasia prostática benigna associada à alteração do PSA, e o elevado risco de exames falso-positivos evidenciam a preocupação com o sobrediagnóstico. No contexto dos dados clinico-epidemiológicos avaliados, a possibilidade de resultados falso-positivos e falso-negativos associados à dosagem do PSA deve ser considerada, ressaltando a importância de adoção de exames complementares para rastreio do CaP.

Introduction: in Brazil, the cancer with the highest incidence in men is prostate cancer (PCa), with 6.9% mortality. Currently, the applicability of prostate specific antigen (PSA) in screening policies for PCa and the risks associated with overdiagnosis are discussed. Objective: to correlate the PSA level with risk factors, clinical history and the presence of prostatic neoplasm. Methods: a cross-sectional descriptive study that analyzed, comparatively, clinical-epidemiological data and serum PSA levels of 200 patients. PSA values were stratified into three categories (<2.5, 2.5­10.0 and> 10 ng / ml). Results: the risk factors analyzed were significantly related to the increase in PSA and prostatic neoplasm. The prevalence of PCa (11%) and prostatic hyperplasia (61%) was observed in patients with higher levels of PSA, while 1% of patients had PCa without PSA changes and 4% had PCa with 2.5­10.0 ng/ml PSA. Increased serum levels of the biomarker were related to diabetes (70%), hypertension (77%), chronic use of medications (60%) and periodic exams (58%). The group with PSA> 10 ng/ml had a mean age greater than the first (p = 0.002) and the second group (p = 0.027). Conclusion: the prevalence of benign prostatic hyperplasia associated with PSA change and an increased risk of false-positive tests show a concern with overdiagnosis. In the context of clinical-epidemiological data, the possibility of false-positive and false-negative results associated with the PSA measurement have to be considered, highlighting the importance of complementary tests for PCa screening.

Prostatic artery embolization for giant prostatic hyperplasia: a single-center experience / Embolização das artérias prostáticas para o tratamento da hiperplasia prostática gigante: experiência de um único centro

Abstract Objective: To describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate. Materials and Methods: This was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms. Results: The PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment. Conclusion: In patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.

Resumo Objetivo: Descrever a segurança e eficácia da embolização das artérias prostáticas (EAP) em pacientes com próstatas muito aumentadas (≥ 200 cm3). Materiais e Métodos: Este estudo retrospectivo incluiu 18 pacientes consecutivos com hiperplasia prostática benigna portadores de próstatas ≥ 200 cm3 (idade média de 74 anos), que foram submetidos a EAP para tratar sintomas de trato urinário inferior moderados a graves. Resultados: A EAP foi tecnicamente bem-sucedida em 17 pacientes (94,4%). Falha clínica (IPSS ≥ 8) foi detectada em dois pacientes durante o seguimento (11,1%). Observamos melhora significativa em todos os parâmetros relevantes aos três meses de acompanhamento: IPSS: 15,7 vs. 2,9; qualidade de vida: 5,2 vs. 1,0); PSA: 11,4 vs. 1,82 ng/mL; pico de fluxo urinário: 7,45 vs. 18,6 mL/s); volume prostático: 252,4 vs. 151,6 cm3; e volume urinário residual: 143,7 vs. 28,3 mL - p < 0,05 para todos). Um paciente (5,6%) apresentou eliminação de tecido prostático e hematúria autolimitada durante o seguimento, que não necessitou de tratamento específico. Conclusão: A EAP em pacientes com próstata muito aumentada foi segura e eficaz, com significativas melhoras clínica, urodinâmica e imaginológica.

Vulnerabilidade de pacientes com hiperplasia prostática tratados com dutasterida e finasterida / Vulnerability of patients with prostatic hyperplasia treated with dutasteride and finasteride / Vulnerabilidad de pacientes con hiperplasia prostática tratados con dutasterida y finasterida

Resumo A hiperplasia prostática benigna é uma patologia cuja incidência vem crescendo muito nos últimos anos, em todo o Brasil. A doença está correlacionada a fatores hormonais, e o tratamento farmacológico pode gerar efeitos adversos nos pacientes. O objetivo deste estudo é avaliar fatores socioeconômicos e socioculturais que interferem na cura ou reduzem a qualidade de vida. Analisamos dados de plataformas do Governo Federal entre janeiro de 2009 a setembro de 2019, observando fatores como etnia, nível de escolaridade e situação econômica dos pacientes. Em todas as regiões do Brasil esses fatores se mostraram importantes, pois podem afetar diretamente a incidência da doença e a adesão e continuidade do tratamento.

Summary Benign prostatic hyperplasia is a pathology whose incidence has been increasing in recent years throughout Brazil. The disease is correlated with hormonal factors, and pharmacological treatment can have adverse effects on patients. This study assesses the socioeconomic and socio-cultural factors that interfere with healing or reduce quality of life. We analyzed data from Federal Government platforms between January 2009 and September 2019, looking at factors such as ethnicity, education level and economic status of patients. In all regions of Brazil, these factors proved to be important, as they can directly affect the incidence of the disease and adherence and continuity of treatment.

Resumen La hiperplasia prostática benigna es una patología cuya incidencia ha ido creciendo mucho en los últimos años, en todo Brasil. La enfermedad se correlaciona con factores hormonales, y el tratamiento farmacológico puede generar efectos adversos en los pacientes. El objetivo de este estudio es evaluar factores socioeconómicos y socioculturales que interfieren con la curación o reducen la calidad de vida. Analizamos datos de plataformas del Gobierno Federal entre enero de 2009 y septiembre de 2019, observando factores como el origen étnico, el nivel educativo y la situación económica de los pacientes. En todas las regiones de Brasil, estos factores demostraron ser importantes, ya que pueden afectar directamente la incidencia de la enfermedad y la adherencia y continuidad del tratamiento.

Manejo anestésico en la enfermedad de Steinert. A propósito de un caso / Anesthetic management in Steinert's disease: case report

Resumen: Se presenta el caso de paciente masculino, de 60 años, programado para resección transuretral de próstata. Como antecedentes destacan enfermedad de Steinert e implantación de marcapasos. La enfermedad de Steinert es el antecedente principal que guiará nuestra práctica anestésica y, tras valorar el tipo de intervención prevista, se decide anestesia locorregional, dadas las potenciales complicaciones que pueden presentar estos pacientes con la anestesia general. La conducta anestésica de los pacientes con enfermedad de Steinert supone un reto para el anestesiólogo tanto por la gran cantidad de complicaciones que pueden aparecer en el intra- y en el postoperatorio, como por la baja frecuencia de esta enfermedad. Además, el estrés quirúrgico y las técnicas utilizadas pueden interferir en el curso de la enfermedad. Por todo ello, el abordaje y los cuidados intra- y postoperatorios se deben planificar y seleccionar con cuidado con el fin de obtener los mejores resultados y extremar la seguridad del paciente.

Abstract: A 60-year-old man with prostatic hypertrophy was scheduled for transurethral resection of the prostate. Steinert's disease and implantation of a pacemaker were his previous pathology. Being Steinert's disease the most relevant clinical characteristic and the type of intervention urologist has planned, we decide locoregional anesthesia technique, avoiding the potential complications that these patients may present with general anesthesia. The anesthetic management of Steinert's disease patients is a challenge for the anesthesiologist both due to the large number of complications that may appear during intra- and postoperative time as well as the low frequency of this pathology. In addition, surgical stress and the techniques we use can interfere with the course of the disease. Therefore, the approach and immediate intra-and postoperative care should be carefully planned and selected in order to obtain the best results and maximize patient safety.

Hiperplasia prostática benigna y síntomas del tracto urinario inferior / Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms

Introducción: La hiperplasia prostática benigna constituye un problema de primer nivel de atención de salud por su alta prevalencia en los hombres. Objetivo: Identificar la presencia de síntomas del tracto urinario inferior relacionados a la hiperplasia prostática benigna y su repercusión en la calidad de vida de hombres de 50 o más años de edad, sin diagnóstico previo de hiperplasia prostática benigna, que asistieron al centro de salud de la parroquia Javier Loyola. Métodos: Estudio descriptivo transversal entre noviembre del 2018 y enero 2019, que incluyó al total pacientes (106), que asistieron al centro de salud de la parroquia Javier Loyola y que aceptaron completar la Escala internacional de síntomas prostáticos. Los datos fueron analizados por medio de la estadística descriptiva y el test de χ2. Resultados: El 35,3 por ciento de investigados pertenecieron al grupo etario de 40 a 50 años, la presencia de síntomas del tracto urinario inferior leves (38,8 por ciento), moderados (39,7 por ciento) y severos (21,5 por ciento). Prevalecieron en porcentaje de participantes los desocupados (22,4 por ciento), los albañiles (23,3 por ciento), los hipertensos (26,7 por ciento), diabéticos (17,2 por ciento) y obesos (14,7 por ciento). La severidad de los síntomas del tracto urinario inferior no se asoció significativamente al tipo de ocupación. El 61,2 por ciento de pacientes presentaban síntomas del tracto urinario inferior moderados o severos y un 56,8 por ciento percibieron que su calidad de vida se veía afectada de alguna manera por los síntomas del tracto urinario inferior. Conclusiones: Preocupa el alto porcentaje de participantes con síntomas del tracto urinario inferior moderados/severos sin un diagnóstico previo de hiperplasia prostática benigna y con percepción de que su calidad de vida se ve afectada. La severidad de los síntomas del tracto urinario inferior incrementó con la edad y no a otros factores, excepto la ocupación(AU)

Introduction: Benign prostatic hyperplasia constitutes a first-level healthcare concern, due to its high prevalence among men. Objective: To identify the presence of lower urinary tract symptoms related to benign prostatic hyperplasia and its impact on the quality of life of men aged 50 years or older, without a previous diagnosis of benign prostatic hyperplasia, who attended the health center of Javier Loyola Parish. Methods: Cross-sectional descriptive study carried out between November 2018 and January 2019, which included all the patients (106) who attended the health center of Javier Loyola Parish and agreed to complete the International Prostate Symptom Scale. The data were analyzed using descriptive statistics and the chi-square test. Results: 35.3 percent of the participants belonged to the age group from 40 to 50 years. The presence was observed of mild (38.8 percent), moderate (39.7 percent) and severe (21.5 percent) lower urinary tract symptoms. There was a prevalence of unemployed (22.4 percent), bricklayers (23.3 percent), hypertensive (26.7 percent), diabetic (17.2 percent) and obese (14.7 percent) participants. The severity of the lower urinary tract symptoms was not significantly associated with the type of occupation. 61.2 percent of patients had mild or severe lower urinary tract symptoms and 56.8 percent perceived that their quality of life was affected, in some way, by lower urinary tract symptoms. Conclusions: There is concern about the high percentage of participants with mild or severe lower urinary tract symptoms, without a previous diagnosis of benign prostatic hyperplasia, and with some perception that their quality of life is affected is. The severity of lower urinary tract symptoms increased with age but not with other factors, except occupation(AU)

Influencia de la modalidad de respuesta, edad y nivel de educación en el cuestionario internacional de síntomas prostáticos (IPSS) / Influence of the response modality, age and level of education in the international prostate symptoms questionnaire (IPSS)

OBJETIVOS: evaluar la influencia de la modalidad de respuesta (paciente vs. asistido por urólogo) en el cuestionario IPSS (International Prostate Symptom Score) y su relación con la edad y nivel de educación. MATERIALES Y MÉTODOS: Análisis prospectivo de 74 pacientes que acudieron a la consulta de urología por síntomas de Hiperplasia Prostática Benigna (HPB) con o sin tratamiento para su patología y que no hayan completado anteriormente el cuestionario internacional de síntomas prostáticos (IPSS). Los cuestionarios fueron completados en la misma consulta urológica, primero por el paciente y luego con ayuda del urólogo. Se categorizó por edad y nivel de educación. Se evaluó la diferencia entre los puntajes de IPSS obtenidos con la forma autocompletada y con asistencia del urólogo y si esta diferencia estaba relacionada con la edad y con el nivel de educación. Los datos fueron analizados utilizando test no paramétrico para datos apareados de Wilcoxon. RESULTADOS: no se encontró diferencia estadísticamente significativa entre el cuestionario completado por el paciente y el asistido por el urólogo. La media del score total fue de 13,66, y 13,67, respectivamente (p: 0.86). Al analizar los subgrupos, con respecto a la edad y al nivel de educación, tampoco se encontraron diferencias estadísticamente significativas. CONCLUSIÓN: en nuestra población de estudio, el cuestionario IPSS no fue influenciado por la modalidad de administración, tampoco por la edad ni por el nivel de educación.

OBJECTIVES: to evaluate the influence of the response modality (patient vs. urologist-assisted) in the IPSS questionnaire (international prostate symptom score) and its relationship with age and education level. MATERIALS AND METHODS: Prospective analysis of 74 patients who came to the urology clinic for symptoms of Benign Prostatic Hyperplasia (BPH) with or without treatment for their pathology and who have not previously completed the international prostate symptoms questionnaire (IPSS). The questionnaires were completed in the same urological consultation, first by the patient and then with the help of the urologist. It was categorized by age and education level. The difference between the IPSS scores obtained with the self-completed form and with the assistance of the urologist and whether this difference was related to age and level of education was evaluated. The data were analyzed using non-parametric test for paired Wilcoxon data. RESULTS: no statistically significant difference was found between the questionnaire completed by the patient and the one assisted by the urologist. The average of the total score was 13.66, and 13.67, respectively (p: 0.86). When analyzing the subgroups, regarding age and level of education, no statistically significant differences were found. CONCLUSION: In our study population, the IPSS questionnaire was not influenced by the modality of administration, neither by age nor by level of education.

La próstata desde una perspectiva inmunológica / The prostate from an immunological perspective

Los procesos inflamatorios e infecciosos que se desencadenan en la próstata, primordial glándula reproductiva masculina, originan las tres principales enfermedades de este órgano: prostatitis, hiperplasia prostática benigna y cáncer. Para entender la relación que existe entre estas tres patologías y los procesos de infección e inflamación, se realizó una revisión de la literatura científica, a conveniencia, en la base de datos PubMed, empleando los términos próstata, prostatitis, hiperplasia prostática benigna y cáncer de próstata. La literatura revisada resalta la importancia del adecuado funcionamiento del sistema inmune en el tejido prostático para eliminar los microorganismos causantes de infecciones, proceso a través del cual se desencadena la inflamación del tejido. Además, infecciones urinarias ascendentes, que culminan en prostatitis crónica, favorecen el desarrollo de la hiperplasia prostática benigna, agrandamiento y fibrosis de la próstata en hombres adultos, e incluso su progresión a cáncer en individuos genéticamente susceptibles. Por otro lado, las limitaciones en el diagnóstico de las alteraciones prostáticas promueven la inflamación crónica, y el uso indiscriminado de antibióticos de amplio espectro para el tratamiento de la prostatitis, impulsa la diseminación sexual de microorganismos multirresistentes al tratamiento. Las alteraciones prostáticas, en especial la prostatitis, continúan siendo patologías enigmáticas de difícil diagnóstico y tratamiento. El estudio de la próstata, sus alteraciones y su relación con el sistema inmune contribuirán a limitar el uso indiscriminado de antibióticos y a reducir los costos en salud y los efectos sobre la calidad de vida de los individuos afectados

Inflammatory and infectious processes triggered in the prostate, the primary male reproductive gland, originate the three main diseases of this organ: prostatitis, benign prostatic hyperplasia and cancer. To understand the relationship between these three pathologies and inflammatory and infectious processes, a review of the scientific literature was carried out in PubMed database using the terms prostate, prostatitis, benign prostatic hyperplasia and prostate cancer. The revised articles highlight the importance of properly immune system functioning in the prostate tissue to remove the microorganisms that cause infections, a process which also triggers tissue inflammation. In addition, ascending urinary infections, which culminate in chronic prostatitis, favor the development of benign prostatic hyperplasia, enlargement and fibrosis of the prostate in adult men, and even its progression to cancer in genetically susceptible individuals. Furthermore, limitations in the diagnosis of prostatic disorders promote chronic inflammation, and the indiscriminate use of broad spectrum antibiotics for prostatitis treatment leads to sexual dissemination of multidrug-resistant microorganisms. Prostatic disorders, especially prostatitis, continue to be enigmatic pathologies of difficult diagnosis and treatment. The study of the prostate, its disorders and its relationship with the immune system will contribute to limit the indiscriminate use of antibiotics and to reduce health costs and the effects on the quality of life of affected individuals

Comparación de los resultados clínicos en pacientes con Hiperplasia prostática benigna con tratamiento inicial Farmacológico, no farmacológico y quirúrgico, atendidos en el Hospital Pablo Arturo Suárez de enero 2014 a diciembre 2016 / Comparison of the clinical results in patients with benign prostatic hyperplasia with initial pharmacological, non-pharmacological and surgical treatment, managed at Pablo Arturo Suárez Hospital from january 2014 to december 2016

Contexto: Al momento existen pocos datos científicos que comparen las tres modalidades de tratamiento en Hiperplasia Prostática Benigna para determinar el mejor resultado clínico, considerando que se trata de una patología cuya incidencia aumenta a medida que aumenta la esperanza de vida poblacional. Objetivo: Comparar los resultados clínicos entre el tratamiento inicial farmacológico, no farmacológico y quirúrgico, basándose en la clínica de prostatismo en pacientes con Hiperplasia Prostática Benigna durante el período de enero 2014 a diciembre 2016. Diseño: Estudio Observacional, tipo Cohorte Retrospectiva. Pacientes y Métodos: Se procedió a dividir a 399 pacientes de acuerdo a la modalidad de tratamiento recibida. Se comparó la disminución del cuadro clínico en la primera consulta postratamiento utilizando una matriz de evaluación de síntomas urinarios elaborada por los autores, basada en la escala IPSS, que estratificó a los pacientes por el grado de severidad de la sintomatología. Se utilizó el software SPSS®. Resultados: Dentro del tratamiento no farmacológico, existió una diferencia de medias de 1,67 (IC 95% 0,49 ­ 2,85, p < 0,05); para el farmacológico fue de 0,21 (IC 95% 0,92 ­ 1,34, p = 0,713) y para el quirúrgico fue de 8,23 (IC 95% 7,19 ­ 9,27, p < 0,05). Se encontraron diferencias significativas entre los tres grupos durante la fase pretratamiento, tras estratificarlos de acuerdo al grado de severidad. Post- intervención, se compararon los resultados clínicos de cada tratamiento hallando que en pacientes con síntomas leves no existieron diferencias significativas (p = 0,087), no así para pacientes con sintomatología moderada y severa en donde se encontró una diferencia estadísticamente significativa. Conclusión: En pacientes con sintomatología urinaria catalogada como moderada y severa dentro de esta muestra, el tratamiento quirúrgico disminuyó la sintomatología urinaria en mayor proporción en comparación con el tratamiento farmacológico y el no farmacológico

Background: Currently there are few scientific data comparing the three therapeutic modalities of Benign Prostatic Hyperplasia to determine the best clinical outcome, considering that it is a pathology whose incidence increases as population life expectancy arise. Objectives: To compare the clinical results between the initial pharmacological, nonpharmacological and surgical treatment, based on clinical signs of prostatism in patients with benign prostatic hyperplasia during the period between January 2014 and December 2016. Study Design: Retrospective Cohort Study. Methods: 399 patients were divided according to the modality of treatment received: nonpharmacological, pharmacological and surgical. The decrease of the symptoms was compared with the first post-treatment consultation by using a matrix of evaluation of urinary symptoms elaborated by the authors, based on SPSS International Score; this tool stratified the patients by the severity of the symptomatology. SPSS® software was used. Results: Within the non-pharmacological treatment, there was a mean difference of 1.67 (95% CI 0.49 - 2.85, p <0.05); for the pharmacological it was 0.21 (95% CI 0.92 - 1.34, p = 0.713) and for the surgical was 8.23 (95% CI 7.19 - 9.27, p <0.05). Significant differences were found between the three groups during the pretreatment phase, after stratifying them according to the degree of severity. Post-intervention, the clinical results of each treatment were compared, finding that in patients with mild symptoms there were no significant differences (p = 0.087), not so for patients with moderate and severe symptoms where a statistically significant difference was found. Conclusion: In patients with urinary symptoms classified as moderate and severe within this sample, surgical treatment decreased urinary symptomatology in greater proportion compared to pharmacological and non-pharmacological treatment

Mecanismos inflamatorios involucrados en la fisiopatología de la hiperplasia prostática benigna / Inflammatory Mechanisms Involved in the Pathophysiology of Benign Prostatic Hyperplasia

La obstrucción del tracto de salida ha sido asociada con la hiperplasia prostática benigna (HPB), dado el crecimiento progresivo del adenoma, lo cual lleva a un incremento en la resistencia al flujo urinario, junto con un efecto deletéreo en la función renal. Se han descrito múltiples teorías asociadas con el desarrollo de la hiperplasia. Entre las cuales se encuentran: La edad, el incremento en la actividad simpática, alteraciones hormonales, el síndrome metabólico y la inflamación crónica. En los últimos años, el rol de la inflamación prostática local en el entendimiento de la patogénesis y progresión de la HPB ha cobrado relevancia. Esa hipótesis plantea que infiltrados inflamatorios conllevan a una lesión tisular, generando así un proceso crónico de cicatrización que condiciona el incremento en el tamaño prostático. El presente artículo se enfoca en describir los mecanismos inflamatorios involucrados en la fisiopatología de la hiperplasia prostática beniga

Urinary tract obstruction has been associated with benign prostatic hyperplasia (BPH), given the progressive adenoma growth. This process leads to an increase in urinary flow resistance, associated with a deleterious effect of renal function. Age, increased sympathetic activity, hormonal alterations, metabolic syndrome and chronic inflammation are among the multiple theories associated with the development of hyperplasia. In recent years, the role of local prostatic inflammation in understanding the pathogenesis and progression of BPH has become relevant. This hypothesis suggests that inflammatory infiltrates lead to a tissue injury, thus generating a chronic healing process that conditions the prostatic increase. The present article focuses on describing the inflammatory mechanisms involved on BPH pathophysiology.

Hiperplasia prostática gigante. Adenocarcinoma. Reporte de un caso / Giant prostatic hyperplasia. Adenocarcinoma. Case report

RESUMEN Se presenta el caso de una hiperplasia prostática gigante, combinada con un adenocarcinoma que se presentó como una tumoración abdominal. El paciente presentaba una tumoración palpable en hipogastrio y un síndrome obstructivo urinario bajo. Se intervino quirúrgicamente y se realizó adenomectomía combinada, transvesical y retropúbica. La biopsia informó pequeño adenocarcinoma prostático acinar Gleason 3-4 puntos, en el contexto de una hiperplasia prostática. El paciente evolucionó satisfactoriamente y se sigue en consulta. La tumoración extraída tenía 736 g y constituye la de mayor peso reportada en Cuba y la quinta a nivel mundial (AU).

ABSTRACT We describe the case of a giant prostatic hyperplasia, combined with an adenocarcinoma presented as an abdominal tumor. The patient had a palpable tumor in the hypogastrium and a low urinary obstructive syndrome. He was operated and a combined, transvesicular and retropubic adenomectomy was performed. The biopsy informed a little 3-4 points-Gleason, acinar, prostatic adenocarcinoma, in the context of a prostatic hyperplasia. The patient evolved satisfactorily and was followed up in consultation. The removed tumor was 736 g, and is the heaviest one reported in Cuba and the fifth worldwide (AU).

Complicaciones infecciosas después de prostatectomía abierta y resección transuretral de próstata en pacientes con hiperplasia prostática benigna / Postoperative infectious complications after open prostatectomy and transurethral resection of the prostate in patients with benign prostatic hyperplasia

RESUMEN La hiperplasia prostática benigna (HPB) es la neoplasia más común en hombres y puede requerir tratamiento quirúrgico cuando hay retención urinaria, uropatía obstructiva, hematuria a repetición, cistolitiasis o falta de mejoría de los síntomas con las terapias farmacológicas. Las opciones quirúrgicas más frecuentes son la prostatectomía abierta y la resección transuretral de próstata, entre cuyas complicaciones están las infecciones del tracto urinario (ITU) hasta en 12,9 % de los pacientes. Sin embargo, este porcentaje es variable porque no siempre se especifica la diferencia entre ITU y bacteriuria. Los siguientes son factores de riesgo: bacteriuria preoperatoria, tiempo quirúrgico mayor de 60 minutos y manipulación posoperatoria de la sonda vesical. Es importante que los profesionales de la salud que participan en la atención de pacientes con HPB conozcan e intervengan estas complicaciones infecciosas y sus factores de riesgo.

SUMMARY Benign prostatic hyperplasia (BPH) is the most common tumor in men and may require surgical treatment when there is urinary retention, obstructive uropathy, recurrent hematuria, cystolithiasis or lack of improvement of symptoms with drug therapies. The most common surgical options are open prostatectomy and transurethral resection of the prostate. Urinary tract infections (UTI) are among the complications of these procedures, and may occur in up to 12.9 % of patients. However, this percentage is variable because the difference between UTI and bacteriuria is not always specified. Risk factors are: preoperative bacteriuria, operating time longer than 60 minutes and handling of postoperative bladder catheter. It is important that health professionals involved in the care of patients with BPH know these infectious complications and their risk factors.

Propuesta algoritmo de cribado para alteraciones morfológicas de la Próstata. Revisión de la evidencia actual / Proposed screening algorithm for morphological alterations of the Prostate. Review of current evidence

Las alteraciones morfológicas de la próstata, por las que se realiza cribado son la hiperplasia prostática benigna (HPB) y el cáncer de próstata (CaP). La HPB es el tumor benigno más frecuente en varones mayores de 50 años, se caracteriza por el aumento del volumen de la glándula y usualmente acompañado de síntomas urinarios. El CaP es la segunda causa de muerte relacionada con cáncer en Estados Unidos y Europa en mayores de 70 años, su incidencia por debajo de los 50 es rara. El cribado o pruebas de detección, tiene como meta el hallar el cáncer antes de la aparición de síntomas, el cribado no se realiza en pacientes por sospechar que tienen cáncer, sino como un método de pesquisa. El objetivo de este artículo, es efectuar una revisión a los referentes teóricos, y proponer un nuevo algoritmo diagnóstico de alteraciones morfológicas de la próstata, basado en la evidencia.

Morphological alterations of the prostate, for which screening is performed include benign prostatic hyperplasia (BPH) and prostate cancer (PCa). BPH is the most common in men over 50 years benign tumor, is characterized by the increase in the volume of the gland and usually accompanied by urinary symptoms. PCa is the second leading cause of cancer-related death in the United States and Europe in over 70 years, the incidence below 50 is rare. Screening or testing, aims the finding cancer before the onset of symptoms, screening is not performed in patients with suspected cancer, but as a method of investigation. The purpose of this article is to review the theoretical framework and propose a new diagnostic algorithm of morphological alterations of the prostate, based on evidence.

Efecto de la tamsulosina en la calidad de vida de pacientes con hiperplasia prostática benigna / The effect of tamsulosin in the quality of life of patients with benign prostatic hyperplasia

Resumen Introducción La hiperplasia prostática benigna es el padecimiento urológico más frecuente en hombres mayores de 50 años; sus síntomas afectan la calidad de vida. Los bloqueadores alfa-adrenérgicos son una opción para mejorarla. Objetivo Determinar la calidad de vida de pacientes con hiperplasia prostática benigna antes y después del tratamiento con un bloqueador alfa-adrenérgico. Material y métodos Estudio pretest-retest en hombres de 45 a 75 años con hiperplasia prostática benigna. Se administró tamsulosina (0.4 mg/día) por tres meses y se evaluó la severidad de los síntomas y la calidad de vida con el International Prostate Symptom Score (IPSS) y EuroQol 5-D. Se usaron X2 y prueba de rangos y signos de Wilcoxon. Resultados Se incluyeron 50 pacientes de 63.3 ± 10.3 años, 34 (68.0%) tenían síntomas severos antes del tratamiento y 19 (38.0%) después de tres meses (p < 0.05). Con el IPSS, 33 (66.0%) pacientes estaban en categorías de «tan insatisfecho como insatisfecho¼ a «muy insatisfecho¼ antes de la intervención y seis (12.0%) después de ella. La escala visual análoga (EVA) del EuroQol 5-D mostró puntuación basal de 72.9 ± 11.2 versus 83.4 ± 7.6 después (p < 0.05). Conclusión La tamsulosina reduce la severidad de los síntomas y mejora la calidad en de vida en la hiperplasia prostática benigna después de administrarla tres meses.

Abstract Introduction Benign prostatic hyperplasia is an urological disorder most common in men over 50 years old; the symptoms affect the quality of life. Alpha-adrenergic blockers are an option to improve it. Objective To determine the quality of life of patients with benign prostatic hyperplasia before and after treatment with an alphaadrenergic blocker. Material and methods Pretest-retest study in men of 45 to 75 years with benign prostatic hyperplasia. Tamsulosin was administered (0.4 mg/day) for three months; the severity of symptoms and quality of life were assessed with IPSS and EuroQol 5-D. Ranges and sign of Wilcoxon test and X2 were used. Results Fifty patients were included of 63.3 ± 10.3 years of age, 34 (68.0%) had severe symptoms before the treatment and 19 (38.0%) after three months (p < 0.05). With IPSS, 33 (66.0%) patients were in the categories of «as dissatisfied as unsatisfied¼ and «very dissatisfied¼ before the intervention and six (12.0%) after. The VAS of the EuroQol 5-D showed a baseline score of 72.9 ± 11.2 versus 83.4 ± 7.6 after (p < 0.05). Conclusion Tamsulosin reduces severity of symptoms and improves quality of life in benign prostatic hyperplasia after giving it three months.